SELF-INFLICTED RATIONING

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 368-368
Author(s):  
B. H.
Keyword(s):  
Lung Cancer ◽  
Liver Transplantation ◽  
Health Service ◽  
Drug Addiction ◽  
Sports Injuries ◽  
Coronary Bypass ◽  
Heart Patients ◽  
Medical Centers ◽  
The Right ◽  
Cardiac Surgeons

Who said the health service could not resolve its funding crisis? Britain's cardiac surgeons have come up with a solution that will solve the government's problems at a stroke: the withdrawal of treatment for self-inflicted sickness. Surgeons at two separate medical centers were reported last week to have withdrawn non-urgent coronary bypass operations from patients who were refusing to give up smoking. The potential for savings seems unlimited if the same principle is applied to other medical cases: drinkers in need of liver transplantation, HIV patients who acquired the infection through drug addiction or promiscuous sex, heart patients who are overweight, accident victims who had been driving carelessly or under the influence of drink, and those with sports injuries, not to mention smokers with lung cancer... The debate raises complex philosophical issues that need to be pursued—eg, the right to use statistics that apply to a category of people to deny treatment to an individual. Yet in an age rightly requiring individuals to take more responsibility for the consequences of their behavior, self-inflicted injuries cannot be totally ignored. Doctors themselves may well revolt when they see politicians shifting responsibility for what are basic rationing decisions on to doctors' shoulders. The issues raised are not primarily medical, but political: what criteria should be used for rationing resources?

Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 227-236 ◽  
Author(s):  
Majno ◽  
Mentha ◽  
Berney ◽  
Bühler ◽  
Giostra ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Therapeutic Option ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Multidisciplinary Program ◽  
First Case ◽  
Living Donor Transplantation ◽  
The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

Why Choose Cardiothoracic Surgery as a Career?

2011 ◽  
Vol 14 (3) ◽  
pp. 142 ◽  
Author(s):  
Raja R. Gopaldas ◽  
Faisal G. Bakaeen ◽  
Danny Chu ◽  
Joseph S. Coselli ◽  
Denton A. Cooley
Keyword(s):  
Technological Progress ◽  
Artery Bypass ◽  
Cardiothoracic Surgery ◽  
Faculty Members ◽  
New Graduates ◽  
The Future ◽  
Cardiac Surgeon ◽  
The Right ◽  
Cardiac Surgeons ◽  
The Ideal

The future of cardiothoracic surgery faces a lofty challenge with the advancement of percutaneous technology and minimally invasive approaches. Coronary artery bypass grafting (CABG) surgery, once a lucrative operation and the driving force of our specialty, faces challenges with competitive stenting and poor reimbursements, contributing to a drop in applicants to our specialty that is further fueled by the negative information that members of other specialties impart to trainees. In the current era of explosive technological progress, the great diversity of our field should be viewed as a source of excitement, rather than confusion, for the upcoming generation. The ideal future cardiac surgeon must be a "surgeon-innovator," a reincarnation of the pioneering cardiac surgeons of the "golden age" of medicine. Equipped with the right skills, new graduates will land high-quality jobs that will help them to mature and excel. Mentorship is a key component at all stages of cardiothoracic training and career development. We review the main challenges facing our specialty�length of training, long hours, financial hardship, and uncertainty about the future, mentorship, and jobs�and we present individual perspectives from both residents and faculty members.

Assessment of knowledge of oral health hygiene among coastal guards in the port trust of south Tamil Nadu - A public health awareness survey

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 1861-1868
Author(s):  
Bianca Princeton ◽  
Abilasha R ◽  
Preetha S
Keyword(s):  
Lung Cancer ◽  
Oral Health ◽  
Oral Hygiene ◽  
Tamil Nadu ◽  
Asbestos Exposure ◽  
The Other ◽  
Oral Manifestations ◽  
Illegal Activities ◽  
The Right ◽  
Oral Hygiene Habits

Oral hygiene is defined as the practice of keeping the mouth clean and healthy, by brushing and flossing to prevent the occurrence of any gum diseases like periodontitis or gingivitis. The main aim of oral health hygiene is to prevent the buildup of plaque, which is defined as a sticky film of bacteria and food formed on the teeth. The coastal guard is an official who is employed to watch the sea near a coast for ships that are in danger or involved with illegal activities. Coastal guards have high possibilities of being affected by mesothelioma or lung cancer due to asbestos exposure. So, a questionnaire consisting of 20 questions was created and circulated among a hundred participants who were coastal guards, through Google forms. The responses were recorded and tabulated in the form of bar graphs. Out of a hundred participants, 52.4% were not aware of the fact that coastal guards have high chances of developing lung cancer and Mesothelioma. 53.7% were aware of the other oral manifestations of lung cancer other than bleeding gums. Majority of the coastal guards feel that they are given enough information about dental hygiene protocols. Hence, to conclude, oral hygiene habits have to be elaborated using various tools in the right manner to ensure better health of teeth and gums.

scholarly journals Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study

2021 ◽  
pp. 0272989X2199895
Author(s):  
Adinda Mieras ◽  
Annemarie Becker-Commissaris ◽  
Hanna T. Klop ◽  
H. Roeline W. Pasman ◽  
Denise de Jong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Multicenter Study ◽  
Systemic Treatment ◽  
Treatment Decision ◽  
Treatment Goals ◽  
Metastatic Lung Cancer ◽  
Prospective Multicenter Study ◽  
Cancer Data ◽  
Metastatic Lung ◽  
The Right

Background Previous studies have investigated patients’ treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. Aim To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. Design and Participants A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. Results According to patients and oncologists, treatment goals were achieved in 30% and 37% for ‘quality of life,’ 49% and 41% for ‘life prolongation,’ 26% and 44% for ‘decrease in tumor size,’ and 44% for ‘cure’, respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment and also if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do ‘something.’ Conclusions Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing ‘something.’

Use of the Right Mammary Artery for Coronary Bypass

1987 ◽  
Vol 21 (5) ◽  
pp. 301-304
Author(s):  
Ram N. Singh ◽  
Paul C. Taylor
Keyword(s):  
Coronary Bypass ◽  
The Right

MINI OPCAB Operation: Surgical Technique

2021 ◽  
Author(s):  
Federico Benetti ◽  
Natalia Scialacomo ◽  
Gustavo Mazzolino
Keyword(s):  
Surgical Technique ◽  
Large Scale ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Revascularization ◽  
Pump Coronary Artery Bypass ◽  
The Right

Introduction: We describe how to perform left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) artery, the so-called MINI Off-pump Coronary Artery Bypass (MINI OPCAB). Materials and Methods: We included patients with a demonstrated predominant ischemia related to the LAD territory. Of 70 patients who were operated upon at the Benetti Foundation, 10 received hybrid revascularization. Surgical Technique: The patient is prepared as for a standard coronary bypass operation through sternotomy. The sternum is opened to the 3rd or 4th intercostal space depending on the anatomy, and a retractor is put in place. The left mammary artery is generally dissected to about 8 cm and isolated without the veins. Importantly, the angle of the superior part, where the mammary artery is attached to the sternum, needs to be below 20% to avoid any potential kinking. The pericardium is cleaned to identify the area of the pulmonary artery. The pericardium is opened to the apex and towards the right to around 5 to 6 cm initially. In most cases, the area of the LAD can be seen and the potential area of the anastomosis is defined. The patient is heparinized and the LAD is occluded with 5-0 Proline. A mechanical stabilizer is put in place and the anastomosis is performed. When the bypass is finished, and before sutures are tied, the stitches of 5-0 polypropylene around the artery are released, along with the clamp of the mammary artery; the anastomosis is then tied. The mechanical stabilizer is removed, the stitches of the pericardium are released and the flow of the graft is measured, while ensuring that there is no kinking. If the flow and Pulsatility and Resistance (PR) are acceptable, the mammary is fixed with 2 stitches of 7-0 polypropylene on both sides around 1 cm from the anastomosis. The heparin is reverted with protamine and a drain is put in place, while taking care to avoid any chance of touching the mammary artery or the anastomosis. The sternum is closed with 1 or 2 wires. Results: Operative mortality in this series was 0%; one patient was converted to sternotomy off-pump (1.4%). None of the grafts were revised after measurement with a Medistim system (Medistim ASA, Oslo, Norway). Fifty five patients (79%) were extubated in the operating room The average hospitalization stay was 60 hours (SD 17, 95% CI). Sixteen patients who underwent the LIMA-to-LAD procedure were restudied, with 100% patency. At 144 months, 82% of the patients were alive and 68% were asymptomatic. Conclusion: Additional clinical experience is required to be able to reproduce this operation on a large scale and expand the MINI OPCAB operation in hybrid revascularization.

scholarly journals Who is the right person to look after the mentally retarded?

Curationis ◽  
1980 ◽  
Vol 3 (3) ◽  
Author(s):  
V. Ehlers
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Residential Care ◽  
National Health ◽  
Mentally Retarded ◽  
Nursing Profession ◽  
Financial Resources ◽  
Mentally Handicapped ◽  
Set Up ◽  
The Right

A committee was set up in Britain in 1975 under the Chairmanship of Mrs Peggy Jay to look into the staffing of mental handicapped residential care in the National Health Service. Part of the task was to consider the Briggs Committee’s recommendation that “… a new caring profession for the mentally handicapped should emerge gradually”. The findings and recommendations of the committee were however radical and far-reaching, involving an enormous shift in financial resources and causing much concern and outcry from the nursing profession which considered the new category of care given as a threat to their existence.

scholarly journals Morphometry of human tricuspid valve: A cadaveric study

2020 ◽  
Vol 11 (3) ◽  
pp. 4487-4491
Author(s):  
Kirti Chaudhary ◽  
Amey Dhatrak ◽  
Brij Raj Singh ◽  
Ujwal Gajbe
Keyword(s):  
Tricuspid Valve ◽  
The Body ◽  
Muscle Pathology ◽  
Male And Female ◽  
Unidirectional Flow ◽  
Significant Difference ◽  
Tissue Flaps ◽  
The Right ◽  
Cardiac Surgeons ◽  
Formalin Fixed

The cardiovascular system consists of a pump represented by the heart and blood vessels, which provide the route by which blood circulates to all parts of the body. William Harvey, in the 17th century, discovered that blood is pumped away from the heart, but it all returns to the heart after circulating in the body. A right ventricular function can be compromised by pressure or stress, often secondary to the right heart valve or muscle pathology. The valves maintain unidirectional flow and permit increased pressure to develop in the chambers. The tricuspid valve consists of three tissue flaps. It separates the right atria and the right ventricle. To measure morphometric measurements of an individual leaflet of the tricuspid valve of cadaveric human hearts. The material for the present study comprised of 50 formalin-fixed adult human hearts (35 males and 15 females) which were obtained from the Department of Anatomy from various medical colleges in Maharashtra. Statistical significant difference was found for the height of anterior and posterior leaflets between male and female hearts. The length of the septal leaflet was also found to be statistically significant between male and female hearts. The study will be helpful for cardiac surgeons in providing data for tricuspid valve complex, leaflets, cords and papillary muscles.

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